A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

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Teaching in the disciplines
Simulation
Learning through simulation has been an established part of nursing and midwifery
education for decades. Role play is discussed in the next section. Simulated environments
such as traditional practical rooms or more modern clinical skills centres (Nicol and
Glen, 1999) create some of the conditions of a practice environment (e.g. ward, outpatient
clinic or client’s home) and permit the practice of psychomotor skills, experiential
learning, discussion and reflection. Advances in technology have brought increasingly
sophisticated mannequins and other simulators, permitting practice of psychomotor
skills such as venepuncture and suturing. Computer-based simulation enables students
to, for example, listen to heart sounds and arrhythmias, or to respond to emergency
situations via an interactive CD ROM. Nelson and Blenkin (2007) describe a sophisticated
online role-play simulation which allows students to experience the outcomes of their
decisions.
Simulation has many advantages. Learning can occur without risk to patients. Students
can be allowed to make mistakes and learn from these. Practical skills can be developed
in a systematic, supported manner, which can be difficult to achieve in busy practice
environments (for a description of one approach to doing this, see the case study by Nicol,
2002: 186–188). Group sizes of 16 to 20 are common and manageable in a skills centre, but
could not be accommodated in practice. Discussion of theoretical and ethical matters can
occur in parallel with developing practical skills in a simulated setting. This would
normally be inappropriate in the presence of a patient and may be forgotten later in a busy
clinical environment.
The development of a key set of basic skills is possible in the early weeks of the preregistration
programme, prior to experiences in practice settings. The most important
skills are those that make placement experiences safer, not only for patients but also for
students and their colleagues: moving and handling, prevention of cross-infection,
checking and recording patient information and so on. Other important skills are those
that will allow students to feel and be viewed by qualified staff as useful members of the
team, for example taking essential observations. This will improve the subsequent
practice-based learning experience of students.
Later in programmes, simulated practice environments are useful for reflection upon
experience in practice areas and drawing out further learning needs, many of which can
be addressed through simulated practice. Thus simulation contributes to the development
of clinical reasoning and to the integration of theory and practice.
Assessment of practical skills in this environment is usually undertaken using an OSCE
(see Chapter 26).
Communication skills
It is almost impossible to name an aspect of practice that does not have communication
as a key element; so it seems somewhat artificial to separate communication skills from